Independent Sector Treatment Centres

23rd November 2006

What is a Treatment Centre?

Treatment Centres (TCs) are dedicated units which offer safe, fast, pre-booked day / short-stay surgery and diagnostic procedures in specialties which have traditionally had the longest waiting times such as ophthalmology, orthopaedics and general surgery. These centres provide high volume elective activity for NHS patients for a range of conditions such as hip and knee replacements, hernia repair and gallbladder and cataract removal.

Treatment Centres are set up and run by the NHS, the independent sector or as a joint venture between the NHS and independent sector. All patients receive the same standard and quality of care regardless of where they are treated.

Why have they been introduced?

These centres have been introduced by the Department of Health (DOH) to provide extra capacity for treating NHS patients.

Although the TC initiative increased NHS capacity it was not sufficient to deliver the NHS Plan targets of:

• A maximum six month waiting time for inpatient treatment by the end of December 2005.• A maximum 18 week wait from referral to treatment by December 2008.

Therefore DOH invited tenders from the private sector to develop and run additional TCs.In 2003 DOH awarded the Wave 1 contracts. A total of 7 private companies received 5 year contracts to provide 24 surgical.

TCs. Contracts were awarded for ‘chain’ schemes (provision of services on multiple sites) and ‘local’ schemes (provision of services on a single site). The majority of contracts were won by healthcare companies from South Africa, the US and Canada.

In 2005 additional contracts were awarded under Wave 2 when a further £3.75bn was made available to increase capacity for NHS patients (£2.75bn for elective procedures and £1bn for diagnostics). These contracts were won by a wider range of companies, including UK private hospital providers.

By 2010 it is anticipated that the ISTCs will provide c.250, 000 elective procedures and 1m diagnostic assessments a year once all units are fully operational. This should account for 7.5% of all elective capacity.

How many centres are running?

Currently there are:

• 46 NHS-run Treatment Centres have been opened. More than 304,000 patients have been treated from April 2003 – March 2006. • 21 Independent Sector Treatment Centres (ISTCs) and a mobile ophthalmology unit. 80,000 elective procedures and 38,000 diagnostic assessments have been carried out; utilisation rates are good – running at 84%.

Atos Origin is a leading international IT services company with revenues of over €5 billion and 47,000 staff. This French company has developed through a series of mergers in Europe, most recently acquiring KPMG Consulting in the UK and Netherlands as well as SchlumbergerSema.

In the UK, Atos Origin has more than 7,000 staff and revenues of over €1 billion, derived through Business Consulting, Systems Integration, Managed Operations and Medical Services. Atos Origin Medical Services is a leading UK provider of managed medical services. The company delivers disability assessment medicine, occupational health, medico-legal services, primary care and diagnostics services. It works closely with leading healthcare authorities and is involved in many strategic initiatives that are transforming the delivery of primary healthcare.

Birkdale Clinic

Birkdale Clinic was established in 1993 to provide services to NHS patients under the GP fundholding scheme. Initially it focused on providing fully comprehensive ophthalmic services and during this period the clinic provided services to 225 GPs at 62 practices across the North West and Yorkshire.

During the past 12 years the clinic has increased its range of services to provide specialist dental surgery, cosmetic and plastic surgery, orthopaedic and general surgery, in addition to ophthalmology.

BUPA

BUPA is an international health and care company based on three continents with more than seven million customers. It provides private health insurance, hospital services and health care services.

As a provident association, BUPA does not have shareholders and reinvests its surpluses into improved health and care facilities such as medical equipment, the latest technology and buildings.

It established the only joint venture ISTC with NHS at the Redwood Centre in Redhill, Surrey. (NHS staff carry out all treatments in a 36 bed Bupa hospital).

Capio

Capio is a leading healthcare provider in Europe. It is a UK based, Swedish owned company which operates in Sweden, Norway, Denmark, Finland, France, the UK, Spain and Switzerland. It has an annual turnover rate of more than €10,000m and comprises more than 100 operating units and 16,000 employees.

The company provides the following services in the UK:

• A network of 21 acute hospitals providing a wide and comprehensive range of specialised and efficient clinical specialties. • A range of specialist mental health treatments for psychological and emotional problems, eating disorders and addictions in specialist facilities in London and Liverpool. • Diagnostic and laboratory medicine, including a specialised histopathology and cytology service and CT and MRI imaging services, on both a fixed and mobile basis to its patients. • ISTC services for 95 000 NHS patients. A total of 10 facilities are being developed; 5 new builds, 2 in NHS facilities and 3 in existing Capio hospitals.• A highly specialised ophthalmology facility offering a range of treatments, in particular cataract surgery.

Clinicenta

Clinicenta is a 50:50 joint venture between Carillion and Lodestone Patient Care It aims to deliver specialist healthcare services through the development, construction and operation of purpose-built Independent Sector Treatment Centres (ISTCs) throughout the UK.

Carillion is one of the UK’s leading providers of business, infrastructure and construction services, with around 20,000 employees worldwide and £2bn annual turnover. Carillion Health is a specialist division within the company, formed to integrate the group’s health planning, design and building expertise with support service management.

Lodestone Patient Care is a wholly owned subsidiary of DCA Group Ltd. (Australia) and as such forms part of the world’s second largest private diagnostic imaging groups – the I-Med network. This ensures that Clinicenta has access to the very latest and best practice in diagnosis and treatment from around the world.

General Medical Clinics

General Medical Clinics PLC is a well-established provider of primary care in the City of London specialising in providing general practice, health screening services, occupational health programmes, physiotherapy, and nurse-led functions such as travel vaccinations.

The company currently operates three private clinics and in 2005 won a five year contract from the Department of Health to run an NHS walk-in centre at Liverpool Street Station. This centre was opened in December 2005 as the first privately run NHS walk-in centre in London.

Interhealth Care Services

Interhealth Care Services UK is a consortium comprising Interhealth Canada and Jarvis Projects Limited. The company has been appointed to run 2 specialist orthopaedic centres in Cheshire & Merseyside and Worcester. Interhealth Canada, a private health care management company, will provide all the clinical services, while Jarvis will be responsible for the construction, refurbishment and facilities management.

Mercury Health

Mercury Health is owned by Tribal Group Plc- the professional services company. The company was set up in response to the ISTC initiative and brings together a range of expertise within Tribal, namely:

• Nightingale Associates – the largest healthcare architectural practice in Europe.• Secta Consulting – specialist public sector consultancy with track record in health.

The company has a strategic alliance with Ascent Health which owns and operates specialty hospitals, day surgery centres, and diagnostic imaging centres in the UK and Ireland. Ascent is a wholly owned subsidiary of Health Inventures, a ten-year old operator of elective healthcare facilities in the United States.

Nations Healthcare Group

Nations Healthcare is a US-led consortium representing the following organisations:

• Johns Hopkins – Named number one US hospital for the 15th consecutive year and Johns Hopkins Medicine which is a $2.7bn integrated healthcare delivery system.• Same Day Surgery – the largest provider of ambulatory care in Chicago.• Alliance Imaging – The largest provider of imaging services in the United States.• Vision Group – Australia’s largest providers of specialised eye care, with a network of ophthalmic clinics and state-of-the-art surgery facilities.• Harvard School of Public Health – Internationally renowned, leading academic institution in the United States.• Nomura – Japanese investment bank and financial services group.• Lawton Communications Group – Leading UK integrated marketing communications agency providing on and offline marketing consultancy and PR.• Willis plc – One of the world’s leading risk management and insurance intermediaries.

This independent company was created to respond to the ISTC initiative.

Netcare UK

Netcare UK is part of Network Healthcare, South Africa’s biggest healthcare provider. The company is one of the world’s largest healthcare groups with 119 hospitals and almost 11,000 beds. The UK operation was established in 2001, and provides specialised clinical services to NHS patients. Existing contracts involve Netcare performing an estimated 90,000 procedures over 5 years.

In 2006, Netcare led a consortium that acquired General Healthcare Group, owner of the UK’s largest independent hospital operator BMI Healthcare. This led to amalgamation of GHG’s public sector division, Amicus Healthcare, with Netcare to further strengthen the company.

Partnership Healthcare Group

PHG is a joint venture between Care UK and Life Healthcare (formerly Afrox Healthcare), one of southern Africa’s leading private hospital operators. PHG was formed in order to bid for the construction and running of the new ISTCs.

Care UK (CUK) was founded in 1994 to provide services in the healthcare market, in particular the provision of specialist care for the elderly and the mentally ill. It operates 90 community-based care homes and independent hospitals supporting older people, those with learning disabilities, mental health problems and children. It also provides over 60,000 hours of support to people in their own homes.

The Life Healthcare Group is one of the largest private hospital operations outside the United States. Its primary business is acute hospital care and comprises one of the most geographic spreads of acute care hospitals and same day surgical centres in South Africa.

UK Specialist Hospitals

UK Specialist Hospitals (UKSH) is a UK-based company providing healthcare to both NHS and private patients. Their first ISTC was opened in July 2005 at Shepton Mallet. It provides elective surgery and diagnostic procedures for NHS patients referred by six local Primary Care Trusts. The company has since been selected as the preferred bidder by DOH to provide a further 6 ISTCs in the South West.